Stranded: Home health licensing foul-up left Canyon City woman stuck in Boise hospital

Published 7:00 am Wednesday, April 17, 2024

In the middle of December 2023, something happened to Pam Bruhn.

She doesn’t remember the incident, but something caused Bruhn, who had been recuperating at home following some health issues, to fall off her bed and lose consciousness. Later, her doctors would diagnose her with several conditions that likely contributed to her collapse.

On the morning of Dec. 17, approximately two days later, her personal caregiver, Dawnna Reed, went to Bruhn’s Canyon City home for her regular Sunday shift. Bruhn didn’t answer the door, or her phone. Her therapy dog, a Great Pyrenees named Gabby, was outside in the cold with no food or water.

“I knew something was wrong,” Reed said.

Reed called for EMTs to do a welfare check, and a neighbor who had a key unlocked the door. Reed found Bruhn on the floor of her bedroom, unresponsive, lying in a pool of her own bodily fluids.

“I went to Blue Mountain Hospital (in John Day), and they life-flighted me to St. Luke’s in Boise,” Bruhn, 63, said. “I was in the ICU for four days.”

As she grew stronger, Bruhn was moved out of the intensive care unit. She still had a long recovery in front of her — when she was admitted to the hospital, she was diagnosed with a neurological condition called toxic encephalopathy, her kidneys were shutting down and she had rhabdomyolysis, which can lead to organ failure. She also had extensive burns on her back from lying too long in bodily fluids.

By the second week of January, Bruhn said, her medical team at St. Luke’s decided she was strong enough to continue her recovery in the comfort of her own home, with her dog and three cats, as long as she had appropriate in-home care. But during discharge planning, they hit an unexpected snag: There was no licensed home health agency in Grant County.

Caught in the middle

For a number of years, Blue Mountain Home Health and Hospice, a division of the publicly owned Blue Mountain Hospital District, had been the sole provider of home health care services in Grant County.

The hospital district was in the process of transferring those services to another division, the Strawberry Wilderness Community Clinic, a move that would allow the district to get higher reimbursements from insurance carriers. But a mix-up occurred in the transition process. According to the Oregon Health Authority, Blue Mountain Home Health and Hospice had surrendered its home health license on Sept. 7, 2023, and Strawberry Wilderness Community Clinic did not yet have the approval required to begin offering home health services.

In an interview for a previous story, Blue Mountain Hospital District CEO Cam Marlowe told the Blue Mountain Eagle that hospital officials did not become aware of the licensing foul-up until late December, when they stopped providing in-home care through Blue Mountain Home Health.

By Jan. 1, Marlowe said, the hospital had found a work-around that allowed it to start offering care to patients in their homes — including skilled nursing, wound care, physical therapy, speech therapy and occupational therapy — without going through either Blue Mountain Home Health and Hospice or the Strawberry Wilderness Community Clinic, neither of which was licensed to do so.

But when St. Luke’s discharge planners tried to make arrangements to get home health care for Bruhn, they got a different response.

On Jan. 10, according to notes in Bruhn’s patient chart from St. Luke’s, a case manager faxed a referral to Blue Mountain Home Health asking for skilled nursing, wound care, physical therapy, occupational therapy and bathing assistance to be provided in Bruhn’s Canyon City home.

The answer came the next day.

The case manager’s assistant “received a call from Erin with Blue Mountain HH and they have declined the patient,” the chart notes state.

In a follow-up call, “Erin stated that the home health is on pause due to Blue Mountain Home Health is currently under inspection and there (is) no nursing available,” the notes continue. “Erin guided us to Out Patient Physical and Wound Care. … However, she said their Outpatient Therapies through the hospital can go out to patient’s home and she could possibly go to Outpatient Wound Care.”

But that arrangement wouldn’t work for Bruhn.

At the time, Bruhn said, she was still very weak and needed skilled nursing care as well as regular wound care for her burns. Having occupational and physical therapy in the home would help, she said, but she was in no condition to drive to the hospital for wound care.

And the discharge planners at St. Luke’s said they could only send her home if they could release her into the care of a licensed home health agency — and there wasn’t one in Grant County.

“It was for my safety,” Bruhn said. “They were very clear: ‘We’re not discharging you to an unsafe situation where you’ll end up back with us.’”

Marlowe declined to comment about Bruhn’s situation for this article, citing medical privacy laws. He did not address questions about whether any other patients seeking certain types of in-home care services since the first of the year have been told those services were not available or whether the full range of in-home services previously provided by Blue Mountain Home Health is available from the hospital or its affiliates.

From bad to worse

Being told no home health care services were available in Grant County was just the first stage of what would become a lengthy medical odyssey for Bruhn.

Unable to safely return home, she stayed at St. Luke’s. And stayed. And stayed.

Eventually, on Jan. 24, more than a month after being flown to the Boise hospital, she was transferred to Saint Alphonsus Hospital in Baker City to continue her recovery in the hospital’s subacute rehabilitation unit.

Shortly after her arrival, Bruhn was diagnosed with COVID-19. She was transferred from the rehab wing to a medical-surgical bed at Saint Alphonsus, where she was put on oxygen and a regimen of IV antiviral medications and steroids.

“I was really sick from COVID — which I wouldn’t have had if I could’ve gotten home,” she said. “For me, it was a huge consequence of having to be at St. Luke’s for so long.”

Counting the costs

On Feb. 5, after 51 days in the Boise and Baker City hospitals, Bruhn was deemed well enough to be released from the hospital and go home to Canyon City, where she is continuing to recover with support from Reed and another personal caregiver.

Since the week of Feb. 12, she also has been able to receive visits from physical therapy, occupational therapy and wound care providers from the Blue Mountain Hospital District, although not under the auspices of a home health agency.

“They found a loophole,” Bruhn said. “It’s not home health, but it is home health.”

Meanwhile, Bruhn has run up substantial expenses for the care of her therapy dog, Gabby, and her three cats, Macy Mae, Max and Grayson James — whom she calls “my family” — while she was in Boise and Baker City.

The biggest expense, of course, will be the hospital bills. She hasn’t seen them yet, but she is worried they could run into six figures. Even with insurance, she’ll have to pay a portion of those costs out of pocket.

“It’s an expensive hotel to stay in a hospital bed,” she said.

What bothers her the most, though, is knowing that it didn’t have to be so bad. If not for the home health licensing issue at the Blue Mountain Hospital District, she believes she would have been home before mid-January, would never have contracted COVID-19 and would have been out of the hospital more than three weeks sooner.

“I’m very disappointed and very angry with the whole mess at the hospital and that there’s not care for community members that deserve good care,” she said.

“Not having home health services for a period of time, that’s just disgraceful,” she added. “This is the only hospital in the county. We have a lot of older people that need help.”

“It’s an expensive hotel to stay in a hospital bed.”

— Pam Bruhn, of Canyon City